INTRODUCTION
Cone beam computed tomography ( CBCT ) is an increasingly important medical imaging modality used in dentistry . Benefits of CBCT include high quality and undistorted images , 1 relatively low cost , 2 and reduced radiation doses compared to other volumetric imaging techniques . 3
CBCT produces accurate , three-dimensional representations of the oral maxillofacial complex , making it an important adjunct in pathologic diagnosis , trauma assessment , and surgical planning . CBCT has become the standard of care for procedures such as implant placement which are now routinely performed by many general dentists . The standard of care also dictates that any practitioner who prescribes CBCT imaging is responsible for interpreting the findings of the entire image , not only the area of concern . 4 General dentists ordering CBCT imaging must therefore have the knowledge necessary to identify and interpret not only the dentoalveolar complex but also the surrounding anatomic structures .
An incidental finding may be defined as any atypical or pathologic finding on a radiograph which is unrelated to the original purpose of ordering the image . 5 The rate of incidental findings , or findings outside of the area of concern , varies with one recent study identifying incidental findings in 92 % of samples studied . 6 Many of these typically asymptomatic findings are variants of normal or benign processes which require no further treatment . However , incidental findings may also be indicative of pathologic or malignant processes which require timely referral for further evaluation and treatment .
Although many of the finding discussed in this manuscript are incidental findings , it is important for clinicians to accurately interpret these findings and understand the significance of them , correlating with clinical and medical history to rule out significant pathology . Clinicians must have the knowledge on when to refer an incidental finding for further evaluation , so patient receives adequate care . This brief review will highlight several common incidental findings and their clinical significance on CBCT images .
Data Sources Relevant images from cases that are part of a dental school practice were used to showcase different findings . Multiple CBCT machines were used to take the images including Planmeca ProMax 3d ( Planmeca Oy , Helsinki , Finland ) and i-CAT Flx ( KaVo , Biberach an der Riss , Germany )
REVIEW OF INCIDENTAL FINDINGS
Figure 1
Axial view of CBCT image showing a well-defined , radiopaque sialolith in the lingual and anterior aspect of the left side of the mandible .
Sialolith Although sialoliths ( Figure 1 ) may present asymptomatically , a history of intermittent discomfort and swelling may be reported which warrant further treatment . 7 Sialolith can contribute to chronic sialadenitis , which is caused by salivary stasis and retrograde seeding of bacteria . 8 They are calcified masses formed by the precipitation of calcium and phosphate around a nidus within a salivary gland . They usually occur as isolated calculi and are found most frequently in the submandibular gland . 9 The incidence of sialoliths reported in the literature ranges from 0.2 to 1.5 %. 5 , 10-12 Missias et al . 2018 noted an overall presence of sialoliths of 1.5 % in their study sample with masses found in the submandibular ( 0.9 %), parotid ( 0.4 %), and sublingual ( 0.2 %) glands . 11 Radiographically , depending on the size sialoliths may appear as round , oval to tear drop shaped radiopaque masses within the salivary glands . Early accurate diagnosis of a patient can help prevent clinical avoidable clinical complications , reduce operative morbidity , and improve patient outcomes .
MAY / JUNE 2022 | PENNSYLVANIA DENTAL JOURNAL 25